Social Work Perspectives in Organ Procurement
Geva, Judith, Weinman, Maxine L., Health and Social Work
Social workers play a key role before and after organ transplantation. Before transplantation, a social worker evaluates the psychosocial profile of a potential recipient to determine if he or she can cope with the emotional, social, and financial aspects. After transplantation, a social worker maintains a therapeutic relationship with the recipient and his or her family and helps them cope with fears of organ rejection, lifestyle issues associated with immunosuppressive drugs, and other psychological implications of living with another person's organ (Dhooper, 1990; Rodgers, 1984; Suszycki, 1988). Social workers are members of ethics committees that establish guidelines and criteria for transplantation procedures and thus influence institutional policies and decisions by presenting the profession's values and ethics (Reamer, 1985).
Most organs for transplantation are obtained from young victims of accidents or other traumatic events. Often, the social worker is one of the first people the victim's family meets on their arrival to the hospital. The social worker usually provides family members with initial information about the accident or traumatic event and helps them in the grieving process. After the family is approached with a request for organ donation, the social worker can help during the decision-making process (Epperson, 1977; Moonilal, 1982; Rehr, 1984). Caplan (1983) argued that it is difficult for a family to make an informed and voluntary decision about organ donation in a time of shock, confusion, and grief. Therefore, a careful and sensitive approach for donation by a person trained in the grief process is essential (Martyn, Wright, & Clark, 1988).
Social work literature has briefly addressed the role of social workers in organ donation as part of crisis intervention. We found only one article (Dhooper & Wilson, 1989) that specifically discussed the role of social work in organ procurement. Because social workers can play an increasingly important role in organ transplantation, it is crucial for social workers to become familiar with the issues involved. This article presents a brief history of organ transplantation and reviews the current policies of organ procurement and their implications for social work practice.
Organ transplantation is not new. A 16th-century drawing by Fernando del Rincon shows a sacristan receiving a healthy leg of a black man to replace his own gangrenous one. In the 17th century Richard Lower of England first transfused blood from one animal to another. Shortly after, Jean-Baptiste Denys in Paris transfused animal blood into a man, which resulted in the man's death. In 1902 Emerich Ullman and Alexis Carrel transplanted one animal kidney into another animal. Kidney transplantation from one identical twin to another was first done in 1954 at the Peter Brent Brisham Hospital in Boston. Transplantation of organs from unrelated donors and cadavers did not occur until later in this century, when the relatively safe suppression of the immune system was discovered (Loewy, 1989). Kidney transplants became acceptable treatment for chronic renal failure in the 1960s; in 1968 Christiaan Neething Barnard performed the first heart transplant (Matas, Arras, Muyskens, Tellis, & Veith, 1985).
Advances in organ transplantation have led to an increased demand that has outgrown the supply of organs. The number of patients waiting for organ transplants increases by about 20 percent each year; in March 1991, 22,692 patients were on the list (First, 1992). The shortage of organs results in low quality of life and even death (Randall, 1991). Dialysis may keep patients alive while waiting for a kidney transplant, but patients with end-stage heart disease or liver failure have no alternative for life support. In 1990 as many as 2,200 potential recipients died while waiting for organs (Kittur, Hogan, Thukral, McGaw, & Alexander, 1992). In 1988 the average waiting time for a kidney was 126 days; in 1991 the average was longer than a year. …